Provider Demographics
NPI:1225074412
Name:BERNS, ELLISON (MD)
Entity Type:Individual
Prefix:DR
First Name:ELLISON
Middle Name:
Last Name:BERNS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 ASYLUM AVE
Mailing Address - Street 2:SUITE 3206
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-1770
Mailing Address - Country:US
Mailing Address - Phone:860-714-7977
Mailing Address - Fax:860-714-9993
Practice Address - Street 1:1000 ASYLUM AVE
Practice Address - Street 2:SUITE 3206
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-1770
Practice Address - Country:US
Practice Address - Phone:860-714-7977
Practice Address - Fax:860-714-9993
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT028734207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0210490004OtherCIGNA HEALTH PLANS
CT001287342Medicaid
010028734CT02OtherBLUE CROSS & BLUE SHIELD
0V6122OtherHEALTHNET
060058732OtherRAILROAD MEDICARE
287340OtherCONNECTICARE
1217506OtherUNITED HEALTHCARE
HAS247OtherOXFORD HEALTH PLANS
2262193OtherAETNA HEALTH PLANS
0210490004OtherCIGNA HEALTH PLANS
C65004Medicare UPIN
060058732OtherRAILROAD MEDICARE